延伸护理对耐多药肺结核患者生命质量和治疗依从性的影响研究

Effects of extended nursing on multidrug-resistant tuberculosis patients’ treatment compliance and life quality

目的探讨延伸护理对耐多药结核病患者治疗依从性和生命质量的影响。方法山东省胸科医院2015年1月至2016年3月期间收入院治疗的110例耐多药结核病患者，在收住院时按住院号的单双号分为常规护理组和延伸护理组，两组各55例。常规护理组患者在出院后采用常规随访，延伸护理组患者在出院后进行延伸护理；研究通过山东省胸科医院伦理委员会批准。统计分析两组患者在出院后6个月的漏服药情况、按时复诊情况和生命质量（采用《SF-36健康调查量表》中的活力、社会功能、心理健康和总体健康4项指标进行评价）改善情况。结果两组患者出院后前6个月的治疗中，延伸护理组死亡、迁往外地、失访各1例，最终纳入52例；常规护理组失访2例，最终纳入53例。延伸护理组未漏服药患者的比率（84．6％，44／52）明显高于常规护理组（58．5％，31／53），差异有统计学意义（χ2=8．13，P=0．004）。延伸护理组94．2％（49／52）的患者能按要求回院复诊，明显高于延伸护理组的77．4％（41／53），差异有统计学意义（χ2=6．10，P=0．023）；延伸护理组《SF-36健康调查量表》中的活力、社会功能、心理健康和总体健康4项指标在出院3个月时的评分[（37．05±1．05）、（38．98±1．23）、（40．05±1．07）、（51．08±2．08）分和6个月时的评分[（40．23±L57）、（40．29±2．03）、（41．95±1．27）、（53．04±2．09）分]均高于常规护理组[3个月时分别为（34．01±1．05）、（35．12±1．06）、（39．23±2．02）、（43．01±1．08）分，6个月时分别为（32．89±2．02）、（36．07±1．99）、（38．85±1．68）、（45．04±2．17）分]，差异均有统计学意义（3个月时，t值分别为14．83、17．24、2．59、25．02，P值分别为0．005、0．005、0．042、0．006；6个月时，t值分别为20．76、10．76、10．65、19．24，P值分别为0．007、0．006、0．003、0．006）。结论延伸护理能够提高耐多药结核病患者的治疗依从性，改善患者生命质量；有必要就延伸护理的标准化服务进行深入研究。

Objective To explore the role of extended nursing on multidrug resistant tuberculosis （MDR-TB） patients＇ treatment compliance and life quality. Methods A total of 110 MDR-TB patients who admitted to the Shandong Provincial Chest Hospital from January 2015 to March 2016 were included in this study. According to their admission numbers （odd or even）, the patients were divided into routine nursing group （RNG） and extended nursing group （ENG） （55 patients in each group）. Patients in the RNG were routinely followed-up, whereas those in the ENG were given extended care after discharge, respectively. The study was approved by the Ethical Commit- tee of Shandong Provincial Chest Hospital. Data on their missed medications, timeliness of clinical revisits, and measurements of life quality （assessed by 4 indicators of the SF-36 health survey scale, including vitality, social func tioning, mental health and general health） 6 months after discharge were collected and analyzed. Results During the first 6 months＇ treatment after discharge, in the ENG, one case died, one moved and one was lost to follow up, and consequently 52 patients were included in this analysis; in the RNG, two patients were lost to follow up, and eventually 53 patients were included in the analysis. The proportion of participants who had not missed any single dosage was higher in the ENG （84. 6%, （44/52） compared to the RNG （58.5%, 31/53）. The difference was statistically significant （±2= 8.13, P=0. 004）. 94.2%（49/52） ENG participants made their revisits regularly, which was significantly higher compared with RNG （77.4%, 41/53）. The difference was statistically significant（χ2 =6. 10, P=0. 023）. The scores of the 4 indicators of SF-36 health survey scale including vitality, social functio- ning, mental health and general health in the ENG at 3-month time-point （（37.05 ± 1.05）, （38.98 ± 1.23）, （40. 05 ± 1.07） and （ 51.08 ±2.08） ） and 6-month time-point after discharge （ （ 40. 23 ±1.57）, （40.29 ± 2.03）, （41.95±1.27） and （53.04±2.09）） were significantly higher than those of the RNG at 3-month time-point （（34.01±1.05）, （35.12 ± 1.06）, （39.23 ±2.02） and （43.01 ±1.08）） and at 6 month time-point （（32.89 ± 2.02）, （36.07 ± 1.99）, （38.85± 1.68） and （45.04 ±2.17））, and the differences were statistically significant （3-month： t=14. 83, 17.24, 2.59, 25.02; P=0. 005, 0. 005, 0. 042, 0. 006; 6 month： t=20.76, 10.76, 10.65, 19.24; P=0.007, 0.006, 0.003, 0.006）. Conclusion MDRTB patients＇ treatment compliance and life quality package in the future. Extended nursing is an effective new tool to improve It is necessary to formulate standard nursing services.